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General NPI Number Information
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NPI Number | 1700069713
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Entity Type | Organization
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Legal Business Name | JAMES A. BUSACK, EYEMD, LLC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 470 W PATRICK ST
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City | FREDERICK
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State | MD
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Zip | 21701-4858
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Country | US
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Telephone | 301-668-2020
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Fax | 301-620-8729
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Provider Business Mailing Address
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Address Line | 470 W PATRICK ST
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City | FREDERICK
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State | MD
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Zip | 21701-4858
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Country | US
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Telephone | 301-668-2020
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Fax | 301-620-8729
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JAMES ANTHONY BUSACK
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Credential | D.O.
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Telephone | 301-668-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | H31629
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License Number State | MD
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